Investigations and Further Management
Bloods on this occasion revealed high inflammatory markers and a worsening acute kidney injury: C-reactive protein was 211mg/L, white blood cells 30.3x109/L, creatinine 298µmol/L, and potassium 6.1mmol/L. The patient was initially medically treated for hyperkalaemia and urosepsis with intravenous insulin, fluids and broad spectrum antibiotics. Following this potassium improved to 4.9mmol/L before increasing to 5.9mmol/L over the subsequent twentyfour hours.
Ultrasound scan of his urinary tract showed persistent bilateral hydronephrosis, likely due to bilateral ureteric obstruction at the point of entry into the inguinal hernia. Emergency nephrostomies were inserted bilaterally. The patient’s clinical condition and blood tests improved with continuing antibiotic and fluid therapy over the subsequent three days.
At this point the management of his hernia was re-assessed and a joint decision was made with the patient that he would have an open inguinal hernia repair on the same admission. Following successful repair of his hernia, nephrostogram showed no further obstruction and hence the nephrostomies were removed. He has had no recurrence of symptoms since his operation.